Yes, Nurse Practitioners Are Well-Equipped to Provide Independent Survivor Care

Mary McCabe, RN, MA

With a shortage of oncologists in the United States, nurse practitioners are ready to take over some of the responsibilities previously carried out by physicians in survivorship care.

An analysis of survivors under the care of nurse practitioners found that patients were provided with quality care in accordance with Institute of Medicine (IOM) standards, demonstrating that nurse practitioners are capable of such duties, according to Mary McCabe, RN, MA. The study was presented at the 2016 Annual Meeting of the American Society of Clinical Oncology (ASCO), a gathering of 30,000 oncology professionals in Chicago, to raise awareness in favor of nurse practitioners.

McCabe, clinical director of the Survivorship Center at Memorial Sloan Kettering Cancer Center in New York City, spoke to Oncology Nursing News about the role of nurse practitioners in survivorship care.

Can you provide an overview of the study and what its purpose is?

We developed a model of care for patients who have developed adult-onset cancer, where, at an appropriate time, the posttreatment care is transitioned from their treating team—the oncologists and nurses—to a nurse practitioner or nurse practitioner group who have expertise in survivorship care. Our purpose is to show that nurse practitioners have the ability to assume independent care of cancer survivors across a set of disease types, they are able to deliver the care that is proposed through the Institute of Medicine report back in 2006, and that they can do it in an efficient matter. We have very busy clinics and a large number of patients to see. We want to not only provide comprehensive care, but do it in a way that is affordable.

How does efficiency play into finance?

I think it’s part of the whole discussion about cost, quality, and how those two things together are important for us to keep in mind. While we want to assure top quality, we want to do it at a price that is affordable within the system so that it can continue to be provided.

What are the key takeaways for our oncology nurse audience?

Nurse practitioners are an excellent set of providers for this period of care after the patient has finished treatment. They are able to do this independently because of their skills as well as their focus on wellness, rehabilitation and recovery. Nurse practitioners not only look at recurrence and provide that surveillance to patients, but they also look at screenings for second cancers and counsel patients throughout. They stress the importance of healthy living because increasingly, we’re aware of the significant role of exercise in terms of not only recovery but in limiting comorbidities and even recurrence of cancers.

In addition to caring for patients, nurse practitioners are able to communicate effectively with patients’ primary care physicians. Our nurse practitioners have been able to demonstrate an important ability to communicate with primary care in a way that’s valued in terms of the information provided.

Can you explain what “shared care” is?

Shared care is the collaboration of physicians from different chronic disease groups, such as the care of the diabetes, cardiovascular diseases, and hypertension. Oncology has just started to adapt in terms of the joint responsibilities between the specialist team and the generalist team. This is going to be critically important going forward because of the aging population. We have an increasing number of patients with cancer and survivors who have comorbidities due to aging. We can’t care for these individuals in silos, because they’re certainly more than their cancer. We need to be a collaborative healthcare team across all groups.

What are the next steps?

Through our study involving over 600 individuals treated for breast, prostate, or colorectal cancers, we’ve been able to demonstrate that we can provide this care. The next step and the harder step is to demonstrate and prove that patients have positive healthcare outcomes because the nurse practitioners are paying attention to the important issues of this population.

What is important to know about survivorship care?

Survivorship care is not one size fits all, but we really can stratify according to risk. We are able to look at populations and determine what their needs are based on a risk assessment. That being said, it is always important to understand the individual with cancer as well as the disease itself. Additional comorbidities such as a history of depression need to be added to the equation in addition to the risk assessment.

What do you think people should know about nurse practitioners and survivorship care?

It is important to highlight the role of the oncology nurse in survivorship care and their extensive influence on the cancer survivor and their family. They hold a leadership role and carry out an essential set of services to aid in medical as well as psychosocial recovery, all while monitoring for cancer recurrence.

Do you think the role of nurse practitioners is being widely accepted by the general community and hospitals?

I think, increasingly, it’s being not only accepted, but embraced. There is a shortage of oncologists and primary care physicians in this country. Nurse practitioners, increasingly, have been able to not only establish their role in the healthcare team but gain respect for their particular expertise.

Do you think people are accepting of nurses taking the lead role in oncology care?

Once we are able to demonstrate with data and evidence that we are not only caring, but we have a skillset to provide quality care that makes a difference in terms of outcomes, our roles as leaders will be accepted.